Chronic Pain: Opiate use can make it worse

For several years a dysfunctional response to opiate prescription medications for chronic pain has been discussed in the medical literature. This dysfunctional response paradoxically makes pain worse! Various animal models have demonstrated “hyperalgesia” (increased pain response to a painful stimulus) in rodents given opiate medications for pain. A process called “central sensitization” occurs in which the nervous system becomes an amplifier (amplifying pain signals to the brain) rather than a muffler (inhibiting pain messages ascending the spinal cord to the brain). Many cellular mechanisms have been identified as potentially contributing to this iatrogenic situation.

A recent study has provided yet another possible contributing mechanism that involves an auto-immune response in which the opiate medication (such has hydrocodone or oxycodone found in NORCO and PERCOCET) chemically combines with a normal protein in human blood. This combination is called a hapten. Haptens have been known to cause a variety of auto-immune diseases including halothane hepatitis and a specific form of hemolytic anemia. Both can be life threatening.

You can view a brief video on the results of the research here:

View this video to understand one of many possible mechanisms causing a paradoxical response to opiate pain medications in which pain is worsened rather than improved.

You can view previous posts related to pain here

and here:

Opiate pain medications such as morphine and fentanyl can be profoundly beneficial in the acute settings of trauma and surgery, but chronic use is rarely justified because of side effects, tolerance and addiction. Instead, lifestyle and rehabilitation modalities should be employed. These can have significant beneficial effects in the setting of chronic pain. I presently practice interventional pain management at TPM Medical Clinic, combining allopathic techniques with lifestyle interventions to help patients get off of chronic opiate medications and improve quality of life and functional status.

The tpmclinic website is an award winning patient educational website that describes various techniques used to treat chronic pain.

This website is devoted to the effects of nutrition, sleep, stress reduction, exercise, sunshine, circadian rhythm and social connection on health and health-span. But all of these factors influence the experience, suffering and prognosis of chronic pain, no matter what the cause.

In the context of the COVID 19 pandemic I will close with the usual summary.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels. Supplement with Vitamin D3 to get your levels above 30 ng/ml, >40ng/ml arguably better.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory “vegetable oils” from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at with regards to household products, personal care products, and organic foods. (
  11. Drink water filtered through a high quality system that eliminates most environmental toxins. (Such as a Berkey or reverse osmosis filter)
  12. HEPA filters or the home-made version (Corsi-Rosenthal box) used in your home or workplace can reduce circulating viral load as discussed on this website.
  13. If you are eligible for vaccination, consider protecting yourself and your neighbor with a few jabs. Age > 50 and/or risk factors (Diabetes, pre-diabetes, insulin resistance, hypertension, obesity, heart disease, COPD, asthma, cancer treatment, immune suppression) suggests benefit from a booster. Risk for complications of boosters in adolescents, especially males, without risk factors, may equal benefit. Previous infection with Covid can be considered as protective as a booster. Discuss risk vs benefits with your doctor.


Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

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